Provider Demographics
NPI:1205293883
Name:WILLIAM SHATTUCK, DDS, PLLC
Entity type:Organization
Organization Name:WILLIAM SHATTUCK, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHATTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-934-9287
Mailing Address - Street 1:295 FM 156
Mailing Address - Street 2:STE 200
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052
Mailing Address - Country:US
Mailing Address - Phone:214-934-9287
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:295 FM 156
Practice Address - Street 2:STE 200
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052
Practice Address - Country:US
Practice Address - Phone:214-934-9287
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831453869OtherINDIVIDUAL NPI